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胃肠道疾病相关性关节炎

Author
Filip Van den Bosch, MD, PhD
Section Editor
Joachim Sieper, MD
Deputy Editor
Paul L Romain, MD
Translators
徐卫东, 主任医师，教授

引言

关节炎是数种疾病和病况中公认的肠外表现之一，相关疾病包括炎症性肠病(inflammatory bowel disease, IBD)、肠道细菌感染、谷蛋白敏感性肠病(乳糜泻)、多种寄生虫感染及假膜性结肠炎，以及肠旁路手术后。其他疾病也有引起关节和肠道炎症的倾向，本专题中讨论的例子包括Behcet综合征和Whipple病。

本文将详细讨论IBD相关性关节炎的临床特点，以及针对克罗恩病和溃疡性结肠炎患者的滑膜炎治疗。IBD的发病机制和治疗将单独讨论。 (参见“Mechanisms for the induction of rheumatic symptoms by gastrointestinal disease”和“炎症性肠病发病机制中免疫和微生物的作用机制”和“成人轻至中度克罗恩病的内科治疗概述”和“重度溃疡性结肠炎的治疗”)

反应性关节炎(以前称为Reiter综合征)、Behcet综合征和Whipple病的治疗也将单独讨论。 (参见“反应性关节炎”，关于‘治疗’一节和“Behçet综合征的治疗”和“Whipple病”，关于‘治疗’一节)

患病率及相关疾病

关节炎在IBD患者中的发生率为6%-46%[1-7]。大肠疾病患者及有并发症的患者发生关节炎的可能性略高，并发症包括脓肿、假膜性息肉、肛周疾病、大出血、结节性红斑、口炎、葡萄膜炎和坏疽性脓皮病等。在克罗恩病患者中，结肠受累患者发生滑膜炎的风险高于仅有小肠疾病的患者。男女受累情况相当。儿童和成人都有可能发生这种IBD并发症。此外，报道称多达2/3的脊柱关节病患者存在经内镜证实的亚临床肠道炎症[8]，一项针对脊柱关节炎(spondyloarthritis, SpA)患者的新前瞻性队列研究证实了这一发现，这些患者根据脊柱关节炎国际评价协会(Assessment in SpondyloArthritis international Society, ASAS)标准进行分类[9]。

溃疡性结肠炎和克罗恩病

在伴关节炎或脊柱炎的特发性IBD中，溃疡性结肠炎和局限性肠炎(克罗恩病)是最常见的类型，将首先进行讨论。其他伴关节疼痛和/或炎症的疾病将在后文讨论。 (参见下文‘其他累及肠和关节的疾病’)

                        

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Literature review current through: 2017-06 . | This topic last updated: 2017-03-10.
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References
Top
  1. Rudwaleit M, Baeten D. Ankylosing spondylitis and bowel disease. Best Pract Res Clin Rheumatol 2006; 20:451.
  2. Lubrano E, Ciacci C, Ames PR, et al. The arthritis of coeliac disease: prevalence and pattern in 200 adult patients. Br J Rheumatol 1996; 35:1314.
  3. Scarpa R, del Puente A, D'Arienzo A, et al. The arthritis of ulcerative colitis: clinical and genetic aspects. J Rheumatol 1992; 19:373.
  4. Leirisalo-Repo M, Turunen U, Stenman S, et al. High frequency of silent inflammatory bowel disease in spondylarthropathy. Arthritis Rheum 1994; 37:23.
  5. de Vlam K, Mielants H, Cuvelier C, et al. Spondyloarthropathy is underestimated in inflammatory bowel disease: prevalence and HLA association. J Rheumatol 2000; 27:2860.
  6. Tromm A, May D, Almus E, et al. Cutaneous manifestations in inflammatory bowel disease. Z Gastroenterol 2001; 39:137.
  7. Atzeni F, Defendenti C, Ditto MC, et al. Rheumatic manifestations in inflammatory bowel disease. Autoimmun Rev 2014; 13:20.
  8. De Keyser F, Elewaut D, De Vos M, et al. Bowel inflammation and the spondyloarthropathies. Rheum Dis Clin North Am 1998; 24:785.
  9. Van Praet L, Van den Bosch FE, Jacques P, et al. Microscopic gut inflammation in axial spondyloarthritis: a multiparametric predictive model. Ann Rheum Dis 2013; 72:414.
  10. Wordsworth P. Arthritis and inflammatory bowel disease. Curr Rheumatol Rep 2000; 2:87.
  11. Inman RD. Arthritis and enteritis--an interface of protean manifestations. J Rheumatol 1987; 14:406.
  12. Weiner SR, Clarke J, Taggart N, Utsinger PD. Rheumatic manifestations of inflammatory bowel disease. Semin Arthritis Rheum 1991; 20:353.
  13. Gravallese EM, Kantrowitz FG. Arthritic manifestations of inflammatory bowel disease. Am J Gastroenterol 1988; 83:703.
  14. Stolwijk C, Pierik M, Landewé R, et al. Prevalence of self-reported spondyloarthritis features in a cohort of patients with inflammatory bowel disease. Can J Gastroenterol 2013; 27:199.
  15. Peeters H, Vander Cruyssen B, Laukens D, et al. Radiological sacroiliitis, a hallmark of spondylitis, is linked with CARD15 gene polymorphisms in patients with Crohn's disease. Ann Rheum Dis 2004; 63:1131.
  16. van Tubergen A, Heuft-Dorenbosch L, Schulpen G, et al. Radiographic assessment of sacroiliitis by radiologists and rheumatologists: does training improve quality? Ann Rheum Dis 2003; 62:519.
  17. Fomberstein B, Yerra N, Pitchumoni CS. Rheumatological complications of GI disorders. Am J Gastroenterol 1996; 91:1090.
  18. McEniff N, Eustace S, McCarthy C, et al. Asymptomatic sacroiliitis in inflammatory bowel disease. Assessment by computed tomography. Clin Imaging 1995; 19:258.
  19. Kitis G, Thompson H, Allan RN. Finger clubbing in inflammatory bowel disease: its prevalence and pathogenesis. Br Med J 1979; 2:825.
  20. Lakatos PL, Lakatos L, Kiss LS, et al. Treatment of extraintestinal manifestations in inflammatory bowel disease. Digestion 2012; 86 Suppl 1:28.
  21. De Keyser F, Van Damme N, De Vos M, et al. Opportunities for immune modulation in the spondyloarthropathies with special reference to gut inflammation. Inflamm Res 2000; 49:47.
  22. Rispo A, Scarpa R, Di Girolamo E, et al. Infliximab in the treatment of extra-intestinal manifestations of Crohn's disease. Scand J Rheumatol 2005; 34:387.
  23. Caprilli R, Gassull MA, Escher JC, et al. European evidence based consensus on the diagnosis and management of Crohn's disease: special situations. Gut 2006; 55 Suppl 1:i36.
  24. Fornaciari G, Salvarani C, Beltrami M, et al. Muscoloskeletal manifestations in inflammatory bowel disease. Can J Gastroenterol 2001; 15:399.
  25. Herfarth H, Obermeier F, Andus T, et al. Improvement of arthritis and arthralgia after treatment with infliximab (Remicade) in a German prospective, open-label, multicenter trial in refractory Crohn's disease. Am J Gastroenterol 2002; 97:2688.
  26. Van Bodegraven AA, Peña AS. Treatment of Extraintestinal Manifestations in Inflammatory Bowel Disease. Curr Treat Options Gastroenterol 2003; 6:201.
  27. Smale S, Natt RS, Orchard TR, et al. Inflammatory bowel disease and spondylarthropathy. Arthritis Rheum 2001; 44:2728.
  28. Takeuchi K, Smale S, Premchand P, et al. Prevalence and mechanism of nonsteroidal anti-inflammatory drug-induced clinical relapse in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol 2006; 4:196.
  29. O'Brien J. Nonsteroidal anti-inflammatory drugs in patients with inflammatory bowel disease. Am J Gastroenterol 2000; 95:1859.
  30. Sandborn WJ, Stenson WF, Brynskov J, et al. Safety of celecoxib in patients with ulcerative colitis in remission: a randomized, placebo-controlled, pilot study. Clin Gastroenterol Hepatol 2006; 4:203.
  31. El Miedany Y, Youssef S, Ahmed I, El Gaafary M. The gastrointestinal safety and effect on disease activity of etoricoxib, a selective cox-2 inhibitor in inflammatory bowel diseases. Am J Gastroenterol 2006; 101:311.
  32. Biancone L, Tosti C, Geremia A, et al. Rofecoxib and early relapse of inflammatory bowel disease: an open-label trial. Aliment Pharmacol Ther 2004; 19:755.
  33. Kirsner JB, Shorter RG. Recent developments in "nonspecific" inflammatory bowel disease (first of two parts). N Engl J Med 1982; 306:775.
  34. Van den Bosch F, Kruithof E, De Vos M, et al. Crohn's disease associated with spondyloarthropathy: effect of TNF-alpha blockade with infliximab on articular symptoms. Lancet 2000; 356:1821.
  35. Generini S, Giacomelli R, Fedi R, et al. Infliximab in spondyloarthropathy associated with Crohn's disease: an open study on the efficacy of inducing and maintaining remission of musculoskeletal and gut manifestations. Ann Rheum Dis 2004; 63:1664.
  36. Moshkowitz M, Oren R, Tishler M, et al. The absorption of low-dose methotrexate in patients with inflammatory bowel disease. Aliment Pharmacol Ther 1997; 11:569.
  37. Marzo-Ortega H, McGonagle D, O'Connor P, Emery P. Efficacy of etanercept for treatment of Crohn's related spondyloarthritis but not colitis. Ann Rheum Dis 2003; 62:74.
  38. Sandborn WJ, Hanauer SB, Katz S, et al. Etanercept for active Crohn's disease: a randomized, double-blind, placebo-controlled trial. Gastroenterology 2001; 121:1088.
  39. De Keyser F, Baeten D, Van den Bosch F, et al. Gut inflammation and spondyloarthropathies. Curr Rheumatol Rep 2002; 4:525.
  40. Schiellerup P, Krogfelt KA, Locht H. A comparison of self-reported joint symptoms following infection with different enteric pathogens: effect of HLA-B27. J Rheumatol 2008; 35:480.
  41. Panush RS, Stroud RM, Webster EM. Food-induced (allergic) arthritis. Inflammatory arthritis exacerbated by milk. Arthritis Rheum 1986; 29:220.
  42. Ratner D, Schneeyour A, Eshel E, Teitler A. Does milk intolerance affect seronegative arthritis in lactase-deficient women? Isr J Med Sci 1985; 21:532.
  43. Carubbi F, Ruscitti P, Pantano I, et al. Jejunoileal bypass as the main procedure in the onset of immune-related conditions: the model of BADAS. Expert Rev Clin Immunol 2013; 9:441.
  44. McGill PE. Rheumatic syndromes associated with parasites. Baillieres Clin Rheumatol 1995; 9:201.
  45. Peng SL. Rheumatic manifestations of parasitic diseases. Semin Arthritis Rheum 2002; 31:228.
  46. McGill PE. Geographically specific infections and arthritis, including rheumatic syndromes associated with certain fungi and parasites, Brucella species and Mycobacterium leprae. Best Pract Res Clin Rheumatol 2003; 17:289.
  47. Baloch HM, Armstrong DT, Pulling TM, Miller LM. Hookworm-associated reactive spondyloarthritis. Arthritis Rheumatol 2014; 66:578.